• Jenna F Kruger, Alice Hm Chen, Alex Rybkin, Kiren Leeds, Dominick L Frosch, and Elizabeth Goldman.
• University of California-San Francisco, 1001 Potrero Ave, Bldg 10, Ward 13, UCSF Box 1364, San Francisco, CA 94110. E-mail: legoldman@medsfgh.ucsf.edu.
• Am J Manag Care. 2014 Jan 1; 20 (11): 901-6.

ObjectivesTo evaluate 1) clinician attitudes towards incorporating cost information into decision making when ordering imaging studies; and 2) clinician reactions to the display of Medicare reimbursement information for imaging studies at clinician electronic order entry.Study DesignFocus group study with inductive thematic analysis.MethodsWe conducted focus groups of primary care clinicians and subspecialty physicians (nephrology, pulmonary, and neurology) (N = 50) who deliver outpatient care in 12 hospital-based clinics and community health centers in an urban safety net health system. We analyzed focus group transcripts using an inductive framework to identify emergent themes and illustrative quotations.ResultsClinicians believed that their knowledge of healthcare costs was low and wanted access to relevant cost information for reference. However, many clinicians believed it was inappropriate and unethical to consider costs in individual patient care decisions. Among clinicians' negative reactions toward displaying costs at order entry, 4 underlying themes emerged: 1) belief that ordering is already limited to clinically necessary tests; 2) importance of prioritizing responsibility to patients above that to the healthcare system; 3) concern about worsening healthcare disparities; and 4) perceived lack of accountability for healthcare costs in the system.ConclusionsAlthough clinicians want relevant cost information, many voiced concerns about displaying cost information at clinician order entry in safety net health systems. Alternative approaches to increasing cost-consciousness may be more acceptable to clinicians.

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